Coastal Medical named R.I.’s first Shared Savings ACO

PROVIDENCE – Coastal Medical Inc., Rhode Island’s largest primary care group practice, was one of 89 medical organizations designated as an accountable care organization, the Centers for Medicare and Medicaid Services announced on late Monday.

Coastal, which has 91 providers in 17 medical offices and provides care to 105,000 patients, is the first medical organization to be designated as a “shared savings” ACO in Rhode Island.

Under the Affordable Care Act, the Medicare Shared Savings Program is designed to encourage better coordination of care for Medicare patients without duplication of services or medical errors, according to Coastal officials.

Under the program, participating medical organizations are required to function as a new type of health care entity, known as an “accountable care organization” or ACOs – accountable for improving the health and experience of care for individuals, while also improving the health of populations and reducing the rate of growth in health care spending.

Earlier this spring, Coastal signed an innovative contract with Blue Cross Blue Shield of Rhode Island to begin a shared savings program with the health insurer. Under the BCBSRI contract, savings in medical costs achieved by Coastal will be shared between the medical group and the health insurer.

As part of its changing patient services, Coastal has also begun to provide seven-day-a-week, 365-day-year primary care coverage through its community-based offices, as a way to improve patient care as well as cut down on unnecessary and expensive emergency room visits.

“The goals of the ACO – improved care coordination, better health outcomes, improved patient experience and reduced costs – are perfectly aligned with Coastal’s ongoing mission of transforming the delivery of health care for our entire population of patients,” said Dr. G. Alan Kurose, president and CEO of Coastal.

“This opportunity to function as an ACO within the Medicare Shared Savings Program is very similar to our opportunity to care for patients under the shared savings contract we signed with Blue Cross & Blue Shield of Rhode Island earlier this year,” added Kurose.

“Better coordinated care is good for patients and it saves money,” said U.S. Health and Human Services Secretary Kathleen Sebelius in prepared remarks. “We applaud every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”

The latest round of ACO “shared savings” designations of medical groups serve a total of 1.2 million people with Medicare in 40 states, according to HHS officials.

Get the most up-to-date data on the Rhode Island and southern Massachusetts business community from the PBN List Center. Download and purchase PBN Lists as well as the complete Book of Lists in Excel format.